Healthcare Provider Details

I. General information

NPI: 1023943610
Provider Name (Legal Business Name): ALEXIS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGEWOOD AVE
ORANGE CA
92868-2051
US

IV. Provider business mailing address

1711 S STONEMAN ST
ANAHEIM CA
92802-2709
US

V. Phone/Fax

Practice location:
  • Phone: 714-743-4187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT148546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: